Long-Term Effect on Mortality of a Home Intervention that Reduces Functional Difficulties in Older Adults: Results from a Randomized Trial

Jefferson Center for Applied Research on Aging and Health, Thomas Jefferson University, Philadelphia, Pennsylvania 19130, USA.
Journal of the American Geriatrics Society (Impact Factor: 4.57). 02/2009; 57(3):476-81. DOI: 10.1111/j.1532-5415.2008.02147.x
Source: PubMed


To evaluate the long-term mortality effect of a home-based intervention previously shown to reduce functional difficulties and whether survivorship benefits differ according to initial mortality risk level.
Two-group randomized trial with survivorship followed up to 4 years from study entry.
Homes of urban community-living elderly people.
Three hundred nineteen adults aged 70 and older with difficulties performing daily activities.
Occupational and physical therapy sessions to instruct participants in compensatory strategies, home modifications, home safety, fall recovery techniques, and balance and muscle strength exercises.
Survival time was number of days between baseline interview and date of death, as determined using data from the National Death Index or December 31, 2005. Participants were stratified according to baseline mortality risk (low, moderate, high) using a prognostic indicator.
At 2 years, intervention participants (n=160) had a 5.6% mortality rate (n=9 deaths) and controls (n=159) a 13.2% rate (n=21 deaths; P=.02). Mortality rates remained lower for intervention participants up to 3.5 years from study entry. At 2 years, intervention participants with moderate mortality risk had a 16.7% mortality rate (n=16 deaths/96), compared with 28.2% for equivalent control group participants (n=24 deaths/85; P=.02). By 3 years, mortality rates were not statistically significantly different between the experimental and control groups.
The intervention extended survivorship up to 3.5 years and maintained statistically significant differences for 2 years. Subjects at moderate mortality risk derived the most intervention benefit. Findings suggest that the intervention could be a low-cost clinical tool to delay functional decline and mortality.

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Available from: Laura N Gitlin, Oct 09, 2015
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    • "Compared to a no-treatment control group, ABLE was shown to reduce functional difficulties and enhance home safety and self-efficacy to manage daily functional challenges at 6 and 12 months. Moreover, ABLE reduced mortality at 12 and 24 months from study entry [15] [16] [17] [18]. Given ABLE's promising outcomes and to extend an understanding of the benefits of this intervention, we conducted an economic analysis post hoc. "
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    ABSTRACT: Evaluating cost effectiveness of interventions for aging in place is essential for adoption in service settings. We present the cost effectiveness of Advancing Better Living for Elders (ABLE), previously shown in a randomized trial to reduce functional difficulties and mortality in 319 community-dwelling elders. ABLE involved occupational and physical therapy sessions and home modifications to address client-identified functional difficulties, performance goals, and home safety. Incremental cost-effectiveness ratio (ICER), expressed as additional cost to bring about one additional year of life, was calculated. Two models were then developed to account for potential cost differences in implementing ABLE. Probabilistic sensitivity analyses were conducted to account for variations in model parameters. By two years, there were 30 deaths (9: ABLE; 21: control). Additional costs for 1 additional year of life was $13,179 for Model 1 and $14,800 for Model 2. Investment in ABLE may be worthwhile depending on society's willingness to pay.
    Journal of aging research 01/2012; 2012(1):680265. DOI:10.1155/2012/680265
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    • "In contrast, Byles identified improved health in their review, but argued that it is hard to identify the underlying mechanism for successful outcomes [3]. Effects found by others were reductions in mortality, functional decline, and admissions to long-term institutional care and hospitals [13] [14] [15] [16]. Further positive tendencies of health effects seen were related to activities of daily living (ADL), physical capacity, falls, and social activities [9] [17] [18], as well as aspects of participation and life satisfaction [5] [19]. "
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    ABSTRACT: The purpose of preventive home visits is to promote overall health and wellbeing in old age. The aim of this paper was to describe the process of the development of evidence-based preventive home visits, targeting independent community-living older persons. The evidence base was generated from published studies and practical experiences. The results demonstrate that preventive home visits should be directed to persons 80 years old and older and involve various professional competences. The visits should be personalized, lead to concrete interventions, and be followed up. The health areas assessed should derive from a broad perspective and include social, psychological, and medical aspects. Core components in the protocol developed in this study captured physical, medical, psychosocial, and environmental aspects. Results of a pilot study showed that the protocol validly identified health risks among older people with different levels of ADL dependence.
    Journal of aging research 01/2012; 2012(2):352942. DOI:10.1155/2012/352942
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